Perimenopause’s emotional toll, especially for women of color, needs attention

Dr Sarah Berg argues that menopause culture can name hot flashes and sleep loss, but still stumbles over rage, unpredictability, and the emotional volatility that many women recognize before anyone gives it a name. The symptom that can upend a career, a marriage, or a sense of self is still the one menopause culture talks about least. For women of color, that blind spot matters twice over, because mood changes can land in workplaces and clinics where bias already shapes how symptoms are heard.

The symptom cluster people keep undercounting

Emotional changes during perimenopause are not a side note to the transition. They can be as disruptive as vasomotor symptoms, and in practice they often show up first as irritability, tearfulness, anxiety, or a short fuse that feels unlike the person having it. Berg ties these changes to estrogen fluctuation, not to a personality flaw or a failure to cope.

The public script still treats visible symptoms as the only “real” ones. A woman who is sweating through meetings gets validation faster than a woman who is suddenly furious, overwhelmed, or unable to track her own mood from one week to the next. The language of menopause care has to widen enough to include identity and emotional stability, not just body heat.

What the research says about mood

A JAMA Psychiatry paper from the long-running, multi-site Study of Women’s Health Across the Nation, or SWAN, followed 3,302 multiethnic women ages 42 to 52 from December 1995 through January 2008 and found that being perimenopausal or postmenopausal remained significantly associated with high depressive symptoms, measured as a CES-D score of 16 or higher. Low social support, stressful life events, and being Hispanic were also independently associated with higher depressive symptoms.

Another analysis tracked irritability as part of a broader anxiety cluster over 10 years. Mood symptoms during the transition are common enough to expect, but specific enough to ask about directly. They are not proof that everything is “just stress,” and they are not separated from the hormonal transition by some tidy wall.

The Menopause Society’s 2024 consensus recommendations state that some women can be bothered by moderate to severe symptoms for a decade or longer and link sleep and mood disturbances with reduced productivity, absenteeism, loss of employment, and early exit from the workforce.

Why women of color may feel the edge more sharply

The disparity is not only in how mood symptoms feel, but in when they arrive and how often they are recognized. In AARP’s May 2026 overview, women of color often reach menopause earlier and spend longer in perimenopause than non-Hispanic white women, and Black women report higher rates of hot flashes, depression, and sleep problems while being less likely to receive hormone therapy or related care. Washington state’s Executive Order 26-01 similarly states that Black, Asian, and Latina women tend to enter menopause earlier than white women.

The Washington order states that many women begin experiencing symptoms in their thirties. Those symptoms can overlap with peak-career years, caregiving, and the exact stage when women are least likely to want to flag emotional strain at work. Add bias in clinical settings, and mood symptoms can be dismissed as overwork, burnout, or a separate mental-health problem before perimenopause is even considered.

Why the policy response is getting louder

Executive Order 26-01 states that about 1.3 million people in the United States transition into menopause each year, 34% of people with menopause symptoms are not diagnosed, and menopause-related work impacts are linked to an estimated $1.8 billion in annual direct losses to the U.S. economy. It also directs the Washington State Women’s Commission and state agencies to develop training materials and policy recommendations, including possible workplace adjustments and reasonable accommodations under the state’s anti-discrimination law.

HB5284, the Illinois Menopause Equity and Care Act, was sent to the governor on June 26, 2026. The bill would require public educational materials on symptoms, treatment options, and patient rights, mandate insurance coverage for medically necessary evaluation and treatment of perimenopause and menopause beginning January 1, 2028, add menopause training to continuing education for licensed providers who treat these conditions, and define menopause-related conditions to include cognitive or mood changes.

A 2026 Harris Poll for Wondr Health found that 68% of employed adults think women should not be expected to “push through” perimenopause or menopause symptoms without acknowledgment at work, and that as many as 1 in 10 women leave their job because unmanaged symptoms become too disruptive. The National Menopause Foundation’s 2026 benchmark tool was built from a survey of 208 organizations.

When mood belongs to perimenopause, and when it needs separate evaluation

Perimenopause can absolutely bring emotional swings, but not every mood change should be folded into hormones and left there. If irritability, anxiety, low mood, or emotional unpredictability arrives alongside sleep disruption, changing cycles, brain fog, or hot flashes, perimenopause belongs on the list of likely causes. If the mood change is severe, persistent, worsening, or comes with thoughts of self-harm, panic, inability to function, or a history of major depression or bipolar disorder, it deserves separate mental-health evaluation as well.

You can tell a GP or primary care clinician that the problem is not only “feeling stressed,” but a pattern of emotional volatility, sleep loss, and cognitive changes that may be tied to the menopausal transition, and that you want both a menopause assessment and a mental-health screen if needed.